Department of Cardiology, Medical University of Bialystok, Poland.
Biomed Res Int. 2019 Aug 19;2019:7846291. doi: 10.1155/2019/7846291. eCollection 2019.
Pulmonary embolism (PE) is one of the most common causes of cardiovascular death. The most often PE etiology is a deep vein thrombosis (DVT) of the lower extremities, but embolic material can arise in pelvic or upper extremity veins as well as in right heart chambers. There is growing number of evidences of atrial fibrillation (AF) involvement in PE. The presence of AF in patients with PE may be both the cause and the consequence of PE. The PE association with AF should be considered in patients without confirmed DVT and with history of AF, which itself is associated with prothrombotic state. The valuable diagnostic method is echocardiography that may bring the insight into source of embolic material. Another possible AF and PE association is the AF as a consequence of an abrupt increase in pulmonary vascular resistance due to the occlusion of the pulmonary vessels. Large-scale population-based studies have provided a considerable body of evidence on the involvement of PE in the onset of subsequent AF. Another important issue is the influence of AF on prognosis in patients with PE. Most investigators demonstrated a negative impact of AF on mortality. The main problem to resolve is whether AF is an independent mortality risk factor or whether it occurs as a result of comorbidities or the severity of a PE episode. Although the pathophysiological basis of this bidirectional relationship exists, many questions are still unresolved and require further studies, including the significance of paroxysmal AF accompanying an acute PE episode, the usefulness of PE risk scales in patients with concomitant AF, and the effect of anticoagulant treatment on PE and AF occurrence. Regardless of the type of AF, clinicians should be alert to the possibility of PE in patients with previous history of AF or presenting with new-onset AF.
肺栓塞（PE）是心血管死亡最常见的原因之一。最常见的 PE 病因是下肢深静脉血栓形成（DVT），但栓子物质也可能来源于骨盆或上肢静脉以及右心腔。越来越多的证据表明心房颤动（AF）与 PE 有关。PE 患者存在 AF 可能既是 PE 的原因，也是其后果。在没有确诊 DVT 且有 AF 病史的患者中，应考虑 PE 与 AF 的关联，因为 AF 本身与促血栓形成状态有关。有价值的诊断方法是超声心动图，它可以深入了解栓子物质的来源。AF 和 PE 之间的另一种可能关联是 AF 是由于肺血管阻力突然增加引起的，这是由于肺血管阻塞所致。大规模的基于人群的研究提供了相当多的证据，表明 PE 在随后发生 AF 中起作用。另一个重要问题是 AF 对 PE 患者预后的影响。大多数研究人员表明 AF 对死亡率有负面影响。需要解决的主要问题是 AF 是否是独立的死亡风险因素，还是由于合并症或 PE 发作的严重程度所致。尽管这种双向关系存在病理生理学基础，但仍有许多问题尚未解决，需要进一步研究，包括急性 PE 发作时伴发阵发性 AF 的意义、在伴有 AF 的患者中使用 PE 风险评分的效用以及抗凝治疗对 PE 和 AF 发生的影响。无论 AF 类型如何，临床医生都应警惕有 AF 既往史或新发 AF 的患者发生 PE 的可能性。
